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health! St. Clare

FROM

ST. CLARE HOSPITAL AND THE OTHER SERVICES OF FRAnCISCAn HEALTH SYSTEM

Donors fund improvements at St. Clare

Are you at risk for

HEART DISEASE? See page 7

Keep your bones strong

See page 15 fo r o u r

Calendar of Events Franciscan Health System • FALL 2011


Facility update

Planning for the future St. Clare Hospital’s renovation will enhance patient care When St. Clare was built over 20 years ago, the hospital was a small, 48-bed facility. And while the structure hasn’t changed much, demands Kathy Bressler, for its services have.Today, President of St. Clare Hospital the Franciscan Health System hospital has grown to a bustling 106-bed facility that provides leading-edge treatment to 150 emergency department patients each day.To better meet the growing health care needs of Lakewood and surrounding communities, St. Clare began a $15.5 million renovation and addition project this past summer.    “This is such an exciting time for us at St. Clare,” explains Kathy Bressler, president of St. Clare Hospital. “Our employees have a great passion for this hospital and the people we serve. These improvements will help us continue to provide excellent patient care into the future.” The two-year, multiphase project is funded by Catholic Health Initiatives, Franciscan Health System’s parent organization.

Artist’s rendition of the upcoming St. Clare renovation.

Each phase of the project will be staggered over two years to cause as little disruption as possible. Every effort will also be made to reduce inconvenience. For example, an escort service will be provided to help patients get to diagnostic services for testing and the café will remain open during the renovation. “This is a wonderful investment in the St. Clare Hosptial Main Lobby Remodel

future of our hospital,” says Kathy. “It reinforces that St. Clare is a great community hospital dedicated to our patients for the long term.”

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now now now Go to www.FHShealth.org/ StClareHospital to learn more about your community hospital.

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St. Clare welcomes Franciscan Orthopedic & Sports Medicine Associates now now now Franciscan Medical Group is pleased to announce the opening of Franciscan Orthopedic & Sports Medicine Associates at St. Clare. Joshua A. Johnston, MD, has moved his practice from Federal Way to Lakewood. Dr. Johnston is an orthopedic surgeon specializing in sports mediJoshua cine, arthroscopic surgery, reconstructive surgery Johnston, MD and trauma, treatment of athletic injuries, and fracture care. He enjoys caring for patients from all walks of life and strives to provide his patients with efficient, thorough and compassionate care. As a Fellow at the Santa Monica Orthopaedic and Sports Medicine Group, a FIFA Centre of Medical Excellence, 4

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Dr. Johnston served as the team physician providing orthopedic care for the L.A. Galaxy and Chivas USA Major League Soccer teams, the U.S. Men’s and Women’s National Soccer Teams, and the Pepperdine University and Santa Monica College athletic departments.

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Franciscan Orthopedic & Sports Medicine Associates Located in the St. Clare Medical Pavilion 11311 Bridgeport Way S.W., Suite 205 Lakewood, WA 98499 253-985-6675

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Rheumatoid arthritis

Stop rheumatoid arthritis in its tracks Early diagnosis is key to better outcomes

If you’re like a lot of people, you may not think twice about everyday activities like combing your hair or walking to the mailbox. But for people who have rheumatoid arthritis (RA), such tasks can seem overwhelming. RA is a chronic disease that causes pain, Dina Titova, MD, swelling, stiffness and a loss of function in PhD the joints. It occurs when the body’s immune system, which normally fights off bacteria and disease, turns on itself and attacks healthy joint tissue. Arrested development

The good news is that, with proper treatment, RA can be controlled, says Dina Titova, MD, PhD, a rheumatologist with Franciscan Medical Group’s ROAD (Rheumatology, Osteoporosis and Arthritic Disease) Clinic. “The earlier the disease is diagnosed, the better the outcome,” Dr.Titova says. “Starting aggressive drug treatment as soon as possible can prevent permanent joint damage.” First, people need to recognize the early signs of RA. All too often, Dr. Titova explains, patients dismiss their symptoms as a normal part of aging. Also, it can be hard to know if you have RA because some symptoms, like joint pain and stiffness, can occur with other diseases. “That’s why it’s so important to have a proper evaluation by your doctor to get an accurate diagnosis.” RA’s warning signs

See your primary care doctor if you experience any of these early RA warning signs: • pain, redness and swelling in the wrists and the small joints in the hands and feet • joint pain in a symmetrical pattern (both sides of body) • morning stiffness lasting more than an hour • joint pain accompanied by fatigue • joint pain and stiffness that improve with physical activity

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Improving quality of life

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“There’s no way to reverse joint damage from rheumatoid arthritis once it’s occurred,” Dr. Titova says. “And there’s no way to prevent RA, although there is clear evidence that smoking does trigger RA in people who are genetically predisposed to developing the disease. The focus is on preventing joint damage with early, aggressive drug therapy that can slow the progression of the disease and even put some patients in remission. “At the ROAD Clinic, we have so many more therapeutic options we can offer patients now to improve their quality of life.”

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Schedule an appointment with your internal medicine provider. Don’t have one? Call 888-825-3227 and get connected with a Franciscan Medical Group doctor today.

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Pain management

Beating chronic pain creates a brighter future Diane Sinclair, 45, remembers the fall as if it happened yesterday. “I was rushing to a meeting at work and stopped by the ladies room,” she says. “The floor was wet. My feet slipped out from under me and before I knew it, I was lying on the floor of the stall.” The fall left Sinclair with a fractured hip, sprained wrist, concussion and slipped disc in her upper spine. Over the next three years, Diane experienced pain on a daily basis. She tried everything: medication, physical therapy, hydrotherapy, massage, chiropractic care and more. Still, she was in agony. Getting out of bed and standing up from a chair were excruciating. “One doctor even told me that I was never going to get better,” she adds. That doctor might have been right if Diane hadn’t found out about the Franciscan Chronic Pain Management Program at St. Clare Hospital. A plan to overcome chronic pain

“The Chronic Pain Management Program is a comprehensive course for people who experience pain on a daily basis that interferes with their day-to-day functioning, productivity at work, emotional well-being and family life,” says Fred Silver, PhD, psychologist and coordinator of the program. Participants who attend have chronic pain from injuries, surgeries, fibromyalgia and other medical conditions. The intensive phase of the program consists of a 20-day course that takes place over four weeks, six to eight hours a day. Treatment includes both individual and group activities with a team of specialists in pain rehabilitation. “Every day of treatment includes training in skills for coping with chronic pain,” Dr. Silver says. These therapies include:

• physical therapy, which involves a gentle reconditioning program • occupational therapy, including training in body mechanics, ergonomics and pacing to prevent reinjury • relaxation techniques, such as meditation Fred Silver, PhD and biofeedback • psychological counseling to help with the emotional effects of chronic pain • consultations with a hospital-based professional such as the dietitian or pharmacist and with program physicians Getting life back on track

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chronic pain, call 888-825-3227 to learn how the Franciscan Chronic Pain Management Program can help you.

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“At the end of the program, many people have significant reductions in pain and are able to reduce their use of narcotics,” Dr. Silver says. “Others experience small improvements in pain, but significant gains in their ability to do everyday things.” For Diane, the program was nothing short of life changing. “My pain went from a nine on a 10-point scale down to a one or a two,” she says. “There are things I can do today that I haven’t been able to do in three years. I can easily put my clothes on. I can swim in the pool. I can dance with my grandchildren. I can spend hours working in the garden. I can do whatever I want. Simply put, I got my life back.”

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Inflammation

Fight inflammation—

and help ward off disease

There is growing concern about the debilitating impact of chronic inflammation—now thought to be the root cause of degenerative disorders like arthritis, obesity, heart disease and cancer. But what exactly is inflammation and why is it so devastating? Normally, inflammation is our body’s protection system.When we have an injury or exposure to a foreign microorganism, our body responds to the threat with inflammation and destroys the alien cells and then returns to normal. Chronic inflammation takes place when the inflammation doesn’t turn off, and instead of protecting our bodies, continues to attack. Scientists think chronic inflammation inside the body could play a role in the development of conditions like heart disease, diabetes, obesity, arthritis and cancer. Why inflammation matters

Over the years, doctors have learned that cancer often arises at sites of inflammation in the body. A study in the Archives of Internal Medicine found that women with higher white blood cell counts—a sign of inflammation— had a greater risk of developing cancer of the breast, colon, lung and uterine lining. Inflammation also goes hand-in-hand with heart disease, notes Franciscan Heart & Vascular Associates cardiologist William Bilnoski, MD. “Inflammation, essentially, is coronary artery disease,” he explains. “Cholesterol attaches to the walls of the arteries and causes an inflammatory response, which can then result in symptoms that are caused by blood vessel blockages.”

Tracking inflammation

One way to check for inflammation is with a blood test to gauge C-reactive protein, or CRP, a protein made by the liver. With inflammation, CRP levels rise. Doctors may order CRP tests to check if some inflammationrelated diseases, such as rheumatoid arthritis or lupus, are getting worse. People with high CRP William Bilnoski, levels also tend to do MD worse after heart attacks than those with more normal levels, notes Dr. Bilnoski. “I use the test only after I’ve done a thorough heart disease risk assessment,” he says. “It can help us determine how aggressively to treat heart disease, and may guide dietary and medication recommendations.” How can you reduce inflammation?

Some experts, including Family Medical Clinic physician Linh Vu, MD, think that what you eat can reduce inflammation in your body. “If inflammation is present, it’s important to balance a patient’s protein and salt intake,” says Dr.Vu. “In our practice, we work to educate the whole family on how to shop for and prepare foods. That means shopping from the perimeter of the store, instead of the aisles which

contain a lot of fatty, salty, snack-type foods like candy and chips.” Other foods to avoid because they might add to inflammation are: • red and processed meats • full-fat dairy products • white bread and white rice Get started now

“Obesity is linked to inflammation in both adults and adolescents, so it is important to get kids eating healthy early,” Dr.Vu says. He adds that shedding pounds helps reduce fluid retention in the body as well as inflammation. Likewise, it also reduces the overall risk for Linh Vu, MD cardiovascular disease and diabetes. Other strategies Dr.Vu recommends to reduce inflammation include exercising at least 30 minutes three times per week and not smoking. These smart moves also target other risk factors for disease, such as artery-clogging cholesterol, which raises heart risks.

Our health care experts have the answers you’re looking for. Call a Franciscan doctor at 888-825-3227 today! 

“Obesity is linked to inflammation in both adults and adolescents, so it is important to get kids eating healthy early.” –Dr. Vu

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Orthopedic care

Fend off fragility fractures

Understand your osteoporosis risk to maintain health and quality of life You may view fragility fractures—when bones break because they cannot withstand body weight during a normal daily activity—as a Patrick later-life concern. Not so, Vaughan, MD says orthopedic surgeon Patrick Vaughan, MD, with Tacoma Orthopaedic Surgeons. “Fractures have their roots in weakened bones, known as osteoporosis. And since bone mass peaks in your 20s, if you’re 35 or older, it’s time to start thinking about preventing this potentially debilitating condition,” Dr.Vaughan explains. Fortunately, with smart prevention and the help of Franciscan Medical Group physicians, you can stay one step ahead of fractures and live a more active, healthier life, whether you’re 29 or 90. Are you at high risk for osteoporosis?

“Osteoporosis means ‘bones with holes,’ and it is reaching epidemic proportions among American women,” says orthopedic surgeon John Bargren, MD, who practices at The Orthopaedic Center in Tacoma. Being female and older increases your risk of developing osteoporosis— though men can develop it, too. Other risks include being Caucasian, being underweight, drinking John Bargren, excessive alcohol or MD coffee, and smoking. Primary care physicians start testing an otherwise healthy woman for osteoporosis between ages 60 and 65 using the DEXA scan. This painless imaging test compares the density of bones in a woman’s hip and lower spine 10

Franciscan Health System | Fall 2011

against composite scores of healthy women in their 20s—the lower the score, the weaker the bones. A score of -2.5 or lower indicates osteoporosis, while -1.0 to -2.5 indicates a less severe bone weakening called osteopenia. Both diagnoses warrant attention, with lifestyle change the usual course of treatment for osteopenia. However, the lower the score, the more likely it is that a physician will recommend both lifestyle change and some form of medication therapy in an effort to decrease long-term fracture risk.   The real and present danger of fractures

“Fragility fractures usually occur in the hip or spine, though wrists and shoulders can also sustain these troubling injuries,” states Dr. Bargren. “Spine fractures may contribute to height loss and spine rounding. Hip fractures require rehabilitation and are more likely to result in loss of independence.” “With the rise in osteoporosis rates, hip Michael Johnson, fractures are becoming MD more common, averaging more than 500,000 each year. That number is projected to increase to 750,000 in 10 years,” says Michael Johnson, MD, a family and sports medicine physician with University Place Medical Clinic. “Both men and women have a one in five chance of sustaining fragility fractures before age 65. However, after 65, the risk for women increases to a one in two chance,” Dr. Johnson says. The reason for this change? Menopause.

Once estrogen production falls, bone density decreases dramatically. Fortunately, there are preventive measures you can take to help protect your bones. Start—or keep—exercising

“Walk for 30 minutes at least three times weekly as a minimum. This kind of weight-bearing exercise is critical to increasing bone mass,” says Dr. Bargren. “Other beneficial activities include hiking, jogging, dancing and aerobics—anything that pits your bones against the force of gravity.” “So while biking or swimming may be great for your heart, make sure you add a weight-bearing activity to your regular fitness routine for your bones.” Bone up at mealtime

The Institute of Medicine recommends supplementing with calcium (1,000 mg for premenopausal women and 1,200 to 1,500 for postmenopausal women) and vitamin D (400 to 800 international units, or IUs, daily). “Taking vitamin D is extremely important in the Pacific Northwest, where sunshine is at a premium,” notes orthopedic surgeon Joshua Johnston, MD, with Franciscan Orthopedic & Sports Medicine Associates. A healthy diet can also help your body get the minor minerals it needs for bone-building such as magnesium, manganese and iron. Many physicians recommend leafy green vegetables and other plant-based foods in addition to obvious calcium sources like Joshua milk and yogurt. Johnston, MD


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Attend one of our free orthopedic health talks. Find one near you by calling 888-825-3227 or go to www.FHShealth.org/classes. Practice balance

Quit smoking

According to the Centers for Disease Control and Prevention (CDC), injuries from home-related falls result in an average of 21 million medical visits and 20,000 deaths each year. They are the leading cause of injury among adults ages 65 years and older in the United States. However, studies show that patients in their 80s and 90s who exercise regularly have improved balance, resulting in fewer falls. Balance exercises help build strength in leg muscles, which help to improve balance and prevent falls. If your balance isn’t what it used to be, start slowly. Stand near a support structure, such as a wall or a table so you can catch yourself if necessary. Stand on one leg for five seconds and then do the same with the other leg every day. After a week, repeat the exercises but try to increase the time to 10 seconds. Ultimately you should set a goal of 15 or 20 seconds each day. It may not seem like much, but you’ll feel steadier and better able to adapt to a sudden incline or decline while walking.

“Many patients in their 30s think the only risk to smoking is lung cancer.They are surprised to learn that smoking leads to greater risk for back pain, osteoporosis and results in longer recovery time to heal after injuries,” says Dr.Vaughan. For fractures, longer recoveries can mean more time off your feet, which negatively impacts long-term mobility, heart health, and increases the risk of infection. Get screened

As noted, most primary care physicians start screening for osteoporosis between the ages of 60 and 65. However, you may be screened as early as age 50 if you have any of the following: • family or personal history of osteoporotic fractures • loss of height, which can indicate spine strength issues • history of steroid or injectable birth control use • smoke or drink excessive alcohol or coffee If you are female, white and

underweight, and fall into any of the risk factors, early screening is extremely important. White women have a greater osteoporotic fracture risk than women of other races or ethnicities. Understand treatment risks

No medication therapy is without risks. In the past, estrogen therapy was used to help prevent bone loss.This may still be an option for some women; however, there is a slight increase in the risk of breast cancer. Other therapies include medications in a class called bisphosphonates.While they can increase bone mass, they do carry a risk of gastrointestinal problems. Prolonged use of bisphosphonates have been found to increase the risk of fractures in some women.Your physician will recommend the best course of treatment for you. The most important thing to do to avoid gastrointestinal issues is to take the medications as directed, sitting up, with a full glass of water. Remain sitting up for at least half an hour and don’t eat for an hour. Bisphosphonates can get stuck in the esophagus and cause irritation. www.FHShealth.org

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Ankle replacement

Walking on air Get active again with total ankle replacement surgery Most people know someone who has had a knee or hip replaced—but an ankle? Thanks to advanced technology, total ankle replacement (TAR) has become an appealing alternative to traditional ankle fusion surgery. For active senior WD Page, it was exactly the surgery he needed to keep him moving pain-free. A full-time missionary known to the Russian orphans he ministers as “Grandpa Dub,” WD had been experiencing ankle pain for a couple Byron Hutchinson, of years. “Walking was very painful, and I had a continual limp,” he says. DPM “It certainly slowed me down.” WD was referred to Byron Hutchinson, DPM, who specializes in reconstructive foot and ankle surgery at his clinic, Franciscan Foot & Ankle Specialists. Dr. Hutchinson found that what had begun with an ankle fracture had developed into end-stage osteoarthritis. Such severe arthritis is the result of progressive wearing down of the cartilage cushion that lines the ankle joint, ultimately resulting in bone-on-bone grinding, pain, Peter Krumins, and loss of function and mobility. While a fairly common condition, MD Dr. Hutchinson thought an uncommon solution might work best.

WD Page’s total ankle replacement was a success!

new hope for arthritic ankles

Upon examination,WD was deemed a good candidate for TAR surgery. And since TAR’s average recovery time is two to two-and-a-half months compared to a staggering four to nine months for ankle fusion surgery,WD thought it was the best option for him. “Ankle replacements have been around for over 40 years, but this is a new technique using new technology,” says Dr. Hutchinson.“What we’ve learned about biomechanics from hip and knee replacements has revolutionized this generation of ankle replacement.” The procedure involves replacing the arthritic ankle with an implant composed of two or three parts that glide easily against each other. “Total ankle replacement surgery gives the ankle near normal motion,” says Peter Krumins, MD, orthopedic surgeon at Tacoma Orthopaedic Surgeons. “And because it places less stress on other joints, it reduces the risk of those joints becoming arthritic in the future.” Fusion surgery is still recommended for younger patients with osteoarthritis, those with severe deformity of the leg, and diabetic patients. After surgery, WD spent just four days at St. Francis Hospital, and began to move his ankle six days later. “The hardest part was waiting for the doctor to tell me I could put weight on my foot again,” he remembers. But after eight weeks, he was up and walking. “That ankle is absolutely performing the way it’s supposed to and doesn’t cause any problems whatsoever,” says WD, happy to be back to his missionary work. “The pain is gone, and I’m back at full speed again.”

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TRUST THE EXPERTS Dr. Hutchinson and Dr. Krumins are two of only a few surgeons in the South Sound regularly performing total ankle replacement surgery. To learn more, call Franciscan Foot & Ankle Specialists at 206-242-6553 or Tacoma Orthopaedic Surgeons at 253-756-0888.

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health! Franciscan

10437ME

A publication of Franciscan Health System

NONPROFIT ORG U.S. POSTAGE

FRANCISCAN HEALTH SYSTEM 1717 South J Street Tacoma, WA 98405

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FRANCISCAN HEALTH SYSTEM

St. Francis Hospital 34515 Ninth Ave S, Federal Way, WA 98003 St. Joseph Medical Center 1717 South J St, Tacoma, WA 98405 St. Clare Hospital 11315 Bridgeport Way SW, Lakewood, WA 98499 St. Elizabeth Hospital 1455 Battersby Ave, Enumclaw, WA 98022 St. Anthony Hospital 11567 Canterwood Blvd NW, Gig Harbor, WA 98332 Franciscan Medical Group 1313 Broadway Plaza, Suite 200, Tacoma, WA 98402 CEO, Franciscan Health System Joe Wilczek President, St. Clare Hospital Kathy Bressler Managing Editor Joan B. Artman Franciscan Health System is part of Catholic Health Initiatives, which has health care facilities throughout the United States. ©2011, Franciscan Health System. All rights reserved. For questions or comments, or if you’d like to be removed from the health! mailing list, please contact us at 253-382-3850, (fax) 253-382-3877, www.FHShealth.org or write to: Editor, Franciscan health!, Franciscan Health System, Marketing & Communications, PO Box 2197, Tacoma, WA 98401-2197.

ABOUT FRANCISCAN HEALTH SYSTEM

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OUR MISSION To create healthier communities OUR VISION To be the South Sound's first choice for healing of mind, body and spirit OUR VALUES Reverence, Integrity, Compassion, Excellence

ST. FRANCIS HOSPITAL • ST. JOSEPH MEDICAL CENTER • ST. CLARE HOSPITAL • ST. ELIZABETH HOSPITAL • ST. ANTHONY HOSPITAL • FRANCISCAN MEDICAL GROUP

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health! - St. Clare Hospital, Fall '11